Dual purpose surgical instrument for cutting and coagulating tissue

ABSTRACT

In one general aspect, various embodiments are directed to an ultrasonic surgical instrument that has an ultrasonic blade that protrudes from an ultrasonic transducer assembly. In some embodiments, the ultrasonic blade coaxially extends through a rotatable tissue cutting blade that is rotatably supported by a housing that supports the ultrasonic transducer assembly. In other embodiments, the ultrasonic blade and the tissue cutting blade are both selectively rotatable relative to the housing. In yet other embodiments, the tissue cutting blade and the ultrasonic blade are supported relative to each other in separate sheaths attached to the housing.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation application under 35 U.S.C. §120 ofU.S. patent application Ser. No. 12/703,879, entitled DUAL PURPOSESURGICAL INSTRUMENT FOR CUTTING AND COAGULATING TISSUE, filed on Feb.11, 2010, now U.S. Pat. No. 8,486,096, the entire disclosure of which ishereby incorporated by reference herein.

BACKGROUND

The present disclosure generally relates to ultrasonic surgical systemsand, more particularly, to ultrasonic systems that allow surgeons toperform cutting and coagulation of tissue.

Over the years, a variety of different types of non-ultrasonicallypowered cutters and shaving devices for performing surgical procedureshave been developed. Some of these devices employ a rotary cuttinginstrument and other devices employ a reciprocating cutting member. Forexample, shavers are widely used in arthroscopic surgery. These devicesgenerally consist of a power supply, a handpiece, and a single-use endeffector. The end effector commonly has an inner and outer tube. Theinner tube rotates relative to the outer tube and will cut tissue withits sharpened edges. The inner tube can rotate continuously oroscillate. In addition, such device may employ a suction channel thattravels through the interior of the inner tube. For example, U.S. Pat.No. 4,850,354 to McGurk-Burleson, et al., discloses a non-ultrasonicallypowered surgical cutting instrument that comprises a rotary cutter forcutting material with a shearing action. It employs an inner cuttingmember which is rotatable within an outer tube. Those devices lack theability to coagulate tissue.

U.S. Pat. No. 3,776,238 to Peyman et al. discloses an ophthalmicinstrument in which tissue is cut by a chopping action set-up by thesharp end of an inner tube moving against the inner surface of the endof an outer tube. U.S. Pat. No. 5,226,910 to Kajiyama et al. disclosesanother surgical cutting instrument that has an inner member which movesrelative to an outer member to cut tissue entering through an aperturein the outer member. Again each of those devices lack the ability tocoagulate tissue.

U.S. Pat. No. 4,922,902 to Wuchinich et al. discloses a method andapparatus for endoscopic removal of tissue utilizing an ultrasonicaspirator. The device uses an ultrasonic probe which disintegratescompliant tissue and aspirates it through a narrow orifice. U.S. Pat.No. 4,634,420 to Spinosa et al. discloses an apparatus and method forremoving tissue from an animal and includes an elongated instrumenthaving a needle or probe, which is vibrated at an ultrasonic frequencyin the lateral direction. The ultrasonic movement of the needlebreaks-up the tissue into fragments. Pieces of tissue can be removedfrom the area of treatment by aspiration through a conduit in theneedle. U.S. Pat. No. 3,805,787 to Banko discloses yet anotherultrasonic instrument that has a probe that is shielded to narrow thebeam of ultrasonic energy radiated from the tip of the probe. In oneembodiment the shield extends past the free-end of the probe to preventthe probe from coming into contact with the tissue. U.S. Pat. No.5,213,569 to Davis discloses a phaco-emulsification needle which focusesthe ultrasonic energy. The focusing surfaces can be beveled, curved orfaceted. U.S. Pat. No. 6,984,220 to Wuchinich and U.S. PatentPublication No. US 2005/0177184 to Easley disclose ultrasonic tissuedissection systems that provide combined longitudinal and torsionalmotion through the use of longitudinal-torsional resonators. U.S PatentPublication no. US 2006/0030797 A1 to Zhou et al. discloses anorthopedic surgical device that has a driving motor for driving anultrasound transducer and horn. An adapter is provided between thedriving motor and transducer for supplying ultrasonic energy signals tothe transducer.

While the use of ultrasonically powered surgical instruments provideseveral advantages over traditional mechanically powered saws, drills,and other instruments, temperature rise in bone and adjacent tissue dueto frictional heating at the bone/tissue interface can still be asignificant problem. Current arthroscopic surgical tools includepunches, reciprocating shavers and radio frequency (RF) devices.Mechanical devices such as punches and shavers create minimal tissuedamage, but can sometimes leave behind ragged cut lines, which areundesirable. RF devices can create smoother cut lines and also ablatelarge volumes of soft tissue; however, they tend to create more tissuedamage than mechanical means. Thus, a device which could provideincreased cutting precision while forming smooth cutting surfaceswithout creating excessive tissue damage would be desirable.

It would be desirable to provide an ultrasonic surgical instrument thatovercomes some of the deficiencies of current instruments. Theultrasonic surgical instruments described herein overcome many of thosedeficiencies.

The foregoing discussion is intended only to illustrate some of theshortcomings present in the field of the invention at the time, andshould not be taken as a disavowal of claim scope.

SUMMARY

In one general aspect, various embodiments are directed to an ultrasonicsurgical instrument that may include a housing that has a motor therein.A cutting blade may be coupled to the motor and be supported forselective rotational travel relative to the housing. At least oneultrasonic transducer may be supported by the housing. An ultrasonicblade may protrude from the at least one ultrasonic transducer such thatthe ultrasonic blade extends coaxially through a lumen in the cuttingblade to protrude through a distal end thereof.

In connection with another general aspect of the present invention,there is provided an ultrasonic surgical instrument that may include ahousing that supports at least one ultrasonic transducer therein. Asubstantially hollow ultrasonic blade may be coupled to the at least oneultrasonic transducer. A cutting blade may extend through thesubstantially hollow ultrasonic blade. The cutting blade may have atissue cutting distal end that protrudes outward from a distal end ofthe substantially hollow ultrasonic blade. A motor may be coupled to thecutting blade for rotating the cutting blade within the substantiallyhollow ultrasonic blade.

In connection with still another general aspect of the presentinvention, there is provided an ultrasonic surgical instrument that mayinclude a housing that supports a motor. a cutting blade may be coupledto the motor and be supported for selective rotational travel relativeto the housing. A least one ultrasonic transducer may be supported bythe housing and have an ultrasonic blade protruding therefrom. Theultrasonic blade may be substantially parallel to the cutting blade.

FIGURES

The features of various embodiments are set forth with particularity inthe appended claims. The various embodiments, however, both as toorganization and methods of operation, together with further objects andadvantages thereof, may best be understood by reference to the followingdescription, taken in conjunction with the accompanying drawings asfollows.

FIG. 1 is a schematic view of a surgical control system embodiment ofthe present invention in use with a non-limiting surgical instrumentembodiment of the present invention;

FIG. 2 is a partial perspective view of a portion of the outer sheathand blade arrangement of the surgical instrument depicted in FIG. 1;

FIG. 3 is a cross-sectional view of the outer sheath and bladearrangement of FIG. 2 taken along line 3-3 in FIG. 2;

FIG. 4 is a partial side elevational view of the outer sheath and bladearrangement of FIGS. 2 and 3;

FIG. 5 is a partial perspective view of another non-limiting outersheath and blade arrangement of the present invention;

FIG. 6 is a partial cross-sectional view of the outer sheath andultrasonic blade of the arrangement depicted in FIG. 5;

FIG. 7 is a cross-sectional view of another non-limiting surgicalinstrument embodiment of the present invention;

FIG. 8 is a cross-sectional view of another non-limiting surgicalinstrument embodiment of the present invention;

FIG. 9 is a cross-sectional view of another non-limiting surgicalinstrument embodiment of the present invention;

FIG. 10 is a cross-sectional view of another non-limiting surgicalinstrument embodiment of the present invention;

FIG. 11 is a cross-sectional view of another non-limiting surgicalinstrument embodiment of the present invention;

FIG. 12 is a perspective view of a portion of the outer sheath and bladearrangement employed by the surgical instrument embodiment of FIG. 11;

FIG. 13 is a side elevational view of another non-limiting surgicalinstrument embodiment of the present invention with portions thereofshown in cross-section;

FIG. 14 is an exploded assembly view of an outer sheath assembly and ashaver blade and an ultrasonic blade of various non-limiting embodimentsof the present invention with the outer sheath shown in cross-section;

FIG. 15 is an exploded assembly view of the surgical instrument of FIG.13;

FIG. 16 is a cross-sectional view of a portion of the surgicalinstrument of FIGS. 13 and 15 with the ultrasonic blade attachedthereto;

FIG. 17 is another view of the surgical instrument of FIG. 16 with theouter sheath assembly being slid over the ultrasonic blade;

FIG. 18 is a cross-sectional view of another non-limiting surgicalinstrument embodiment of the present invention; and

FIG. 19 is a cross-sectional end view of the surgical instrument of FIG.18 taken along line 19-19 in FIG. 18.

DESCRIPTION

The owner of the present application also owns the following U.S. patentapplications that were filed on even date herewith and which are hereinincorporated by reference in their respective entireties:

U.S. patent application Ser. No. 12/703,860, entitled ULTRASONICALLYPOWERED SURGICAL INSTRUMENTS WITH ROTATING CUTTING IMPLEMENT, now U.S.Pat. No. 8,531,064;

U.S. patent application Ser. No. 12/703,864, entitled METHODS OF USINGULTRASONICALLY POWERED SURGICAL INSTRUMENTS WITH ROTATABLE CUTTINGIMPLEMENTS, now U.S. Pat. No. 8,323,302;

U.S. patent application Ser. No. 12/703,866, entitled SEAL ARRANGEMENTSFOR ULTRASONICALLY POWERED SURGICAL INSTRUMENTS, now U.S. PatentApplication Publication No. 2011/0196398;

U.S. patent application Ser. No. 12/703,870, entitled ULTRASONICSURGICAL INSTRUMENTS WITH ROTATABLE BLADE AND HOLLOW SHEATHARRANGEMENTS, now U.S. Patent Application Publication No. 2011/0196399;

U.S. patent application Ser. No. 12/703,875, entitled ROTATABLE CUTTINGIMPLEMENT ARRANGEMENTS FOR ULTRASONIC SURGICAL INSTRUMENTS, now U.S.Pat. No. 8,469,981;

U.S. patent application Ser. No. 12/703,877, entitled ULTRASONICSURGICAL INSTRUMENTS WITH PARTIALLY ROTATING BLADE AND FIXED PADARRANGEMENT, now U.S. Pat. No. 8,382,782;

U.S. patent application Ser. No. 12/703,885, entitled OUTER SHEATH ANDBLADE ARRANGEMENTS FOR ULTRASONIC SURGICAL INSTRUMENTS, now U.S. Pat.No. 8,579,928;

U.S. patent application Ser. No. 12/703,893, entitled ULTRASONICSURGICAL INSTRUMENTS WITH MOVING CUTTING IMPLEMENT, now U.S. PatentApplication Publication No. 2011/0196404; and

U.S. patent application Ser. No. 12/703,899, entitled ULTRASONICSURGICAL INSTRUMENT WITH COMB-LIKE TISSUE TRIMMING DEVICE, now U.S. Pat.No. 8,419,759.

Various embodiments are directed to apparatuses, systems, and methodsfor the treatment of tissue Numerous specific details are set forth toprovide a thorough understanding of the overall structure, function,manufacture, and use of the embodiments as described in thespecification and illustrated in the accompanying drawings. It will beunderstood by those skilled in the art, however, that the embodimentsmay be practiced without such specific details. In other instances,well-known operations, components, and elements have not been describedin detail so as not to obscure the embodiments described in thespecification. Those of ordinary skill in the art will understand thatthe embodiments described and illustrated herein are non-limitingexamples, and thus it can be appreciated that the specific structuraland functional details disclosed herein may be representative and do notnecessarily limit the scope of the embodiments, the scope of which isdefined solely by the appended claims.

Reference throughout the specification to “various embodiments,” “someembodiments,” “one embodiment,” or “an embodiment”, or the like, meansthat a particular feature, structure, or characteristic described inconnection with the embodiment is included in at least one embodiment.Thus, appearances of the phrases “in various embodiments,” “in someembodiments,” “in one embodiment,” or “in an embodiment”, or the like,in places throughout the specification are not necessarily all referringto the same embodiment. Furthermore, the particular features,structures, or characteristics may be combined in any suitable manner inone or more embodiments. Thus, the particular features, structures, orcharacteristics illustrated or described in connection with oneembodiment may be combined, in whole or in part, with the featuresstructures, or characteristics of one or more other embodiments withoutlimitation.

Various embodiments are directed to improved ultrasonic surgical systemsand instruments configured for effecting tissue dissecting, cutting,and/or coagulation during surgical procedures as well as the cuttingimplements employed thereby. In one embodiment, an ultrasonic surgicalinstrument apparatus is configured for use in open surgical procedures,but has applications in other types of surgery, such as arthroscopic,laparoscopic, endoscopic, and robotic-assisted procedures. Versatile useis facilitated by selective use of ultrasonic energy and the selectiverotation of the cutting/coagulation implement and/or protective sheaths.

It will be appreciated that the terms “proximal” and “distal” are usedherein with reference to a clinician gripping a handpiece assembly.Thus, an end effector is distal with respect to the more proximalhandpiece assembly. It will be further appreciated that, for convenienceand clarity, spatial terms such as “top” and “bottom” also are usedherein with respect to the clinician gripping the handpiece assembly.However, surgical instruments are used in many orientations andpositions, and these terms are not intended to be limiting and absolute.

FIG. 1 illustrates in schematic form one embodiment of a surgicalcontrol system 10 of the present invention that may be employed tocontrol various surgical instrument embodiments of the presentinvention. For example, the surgical control system 10 may include anultrasonic generator 12 for supplying ultrasonic control signals to anultrasonic surgical instrument 100. The ultrasonic generator 12 may beconnected by a cable 14 to an ultrasonic transducer assembly 114 that isnon-rotatably supported within a housing 102 of the ultrasonic surgicalinstrument 100. In one embodiment, the system 10 may further include amotor control system 20 that includes a conventional power supply 22that is coupled to a control module 24 by cable 23 to supply, forexample, 24 VDC thereto. The motor control module 24 may comprise acontrol module manufactured by National Instruments of Austin, Tex.under Model No. NI cRIO-9073. However, other conventional motor controlmodules may be employed. The power supply 22 may be coupled to a motordrive 26 by cable 25 to also supply 24 VDC thereto. The motor drive 26may comprise a motor drive manufactured by National Instruments.However, other conventional motor drives may be employed. Control module24 may also be coupled to the motor drive 26 by cable 27 for supplyingpower thereto. A conventional foot pedal 30 or other control switcharrangement may be attached to the control module 24 by a cable 31. Aswill be discussed in further detail below, the ultrasonic surgicalinstrument 100 may include a motor 190 that has an encoder 194associated therewith. The motor 190 may comprise a motor manufactured byNational Instruments under Model No. CTP12ELF10MAA00. The encoder 194may comprise an encoder manufactured by U.S. Digital of Vancouver, Wash.under Model No. 197-I-D-D-B. However, other conventional motors andconventional encoders may be used. The encoder 194 may be coupled to themotor control module 24 by an encoder cable 32 and the motor 190 may becoupled to the motor drive 26 by cable 33. The surgical system 10 mayalso include a computer 40 that may communicate by Ethernet cable 42with the motor control module 24.

As can also be seen in FIG. 1, the motor control system 20 may be housedin an enclosure 21. To facilitate easy portability of the system,various components may be attached to the motor control system 20 byremovable cable connectors. For example, foot pedal switch 30 may beattached to a detachable cable connector 37 by cable 35 to facilitatequick attachment of the foot pedal to the control system 20. A/C powermay be supplied to the power supply 22 by a conventional plug/cable 50that is attached to a detachable cable connector 54 that is attached tocable 52. The computer 40 may have a cable 60 that is attached todetachable cable connector 62 that is coupled to cable 42. The encoder194 may have an encoder cable 70 that is attached to a detachableconnector 72. Likewise, the motor 190 may have a cable 74 that isattached to the detachable connector 72. The detachable connector 72 maybe attached to the control module 24 by cable 32 and the connector 72may be attached to the motor drive 26 by cable 33. Thus, cable connector72 serves to couple the encoder 194 to the control module 24 and themotor 190 to the motor drive 26. The cables 70 and 74 may be housed in acommon sheath 76.

In various embodiments, the ultrasonic generator 12 may include anultrasonic generator module 13 and a signal generator module 15. SeeFIG. 1. The ultrasonic generator module 13 and/or the signal generatormodule 15 each may be integrated with the ultrasonic generator 12 or maybe provided as a separate circuit module electrically coupled to theultrasonic generator 12 (shown in phantom to illustrate this option). Inone embodiment, the signal generator module 15 may be formed integrallywith the ultrasonic generator module 13. The ultrasonic generator 12 maycomprise an input device 17 located on a front panel of the generator 12console. The input device 17 may comprise any suitable device thatgenerates signals suitable for programming the operation of thegenerator 12 in a known manner. Still with reference to FIG. 1, thecable 14 may comprise multiple electrical conductors for the applicationof electrical energy to positive (+) and negative (−) electrodes of anultrasonic transducer assembly 114. In alternative embodiments, theultrasonic drive module and/or the motor drive module may be supportedwithin the surgical instrument 100.

Various forms of ultrasonic generators, ultrasonic generator modules andsignal generator modules are known. For example, such devices aredisclosed in commonly owned U.S. patent application Ser. No. 12/503,770,now U.S. Pat. No. 8,461,744, entitled Rotating Transducer Mount ForUltrasonic Surgical Instruments, filed Jul. 15, 2009, which is hereinincorporated by reference in its entirety. Other such devices aredisclosed in one or more of the following U.S. patents, all of which areincorporated by reference herein: U.S. Pat. No. 6,480,796 (Method forImproving the Start Up of an Ultrasonic System Under Zero LoadConditions); U.S. Pat. No. 6,537,291 (Method for Detecting a Loose Bladein a Handle Connected to an Ultrasonic Surgical System); U.S. Pat. No.6,626,926 (Method for Driving an Ultrasonic System to ImproveAcquisition of Blade Resonance Frequency at Startup); U.S. Pat. No.6,633,234 (Method for Detecting Blade Breakage Using Rate and/orImpedance Information); U.S. Pat. No. 6,662,127 (Method for DetectingPresence of a Blade in an Ultrasonic System); U.S. Pat. No. 6,678,621(Output Displacement Control Using Phase Margin in an UltrasonicSurgical Handle); U.S. Pat. No. 6,679,899 (Method for DetectingTransverse Vibrations in an Ultrasonic Handle); U.S. Pat. No. 6,908,472(Apparatus and Method for Altering Generator Functions in an UltrasonicSurgical System); U.S. Pat. No. 6,977,495 (Detection Circuitry forSurgical Handpiece System); U.S. Pat. No. 7,077,853 (Method forCalculating Transducer Capacitance to Determine Transducer Temperature);U.S. Pat. No. 7,179,271 (Method for Driving an Ultrasonic System toImprove Acquisition of Blade Resonance Frequency at Startup); and U.S.Pat. No. 7,273,483 (Apparatus and Method for Alerting Generator Functionin an Ultrasonic Surgical System).

In various embodiments, the housing 102 may be provided in two or moresections that are attached together by fasteners such as screws, snapfeatures, etc. and may be fabricated from, for example, plastics such aspolycarbonate, polyetherimide (GE Ultem®) or metals such as aluminum,titanium or stainless steel. As indicated above, the housing 102non-rotatably supports a piezoelectric ultrasonic transducer assembly114 for converting electrical energy to mechanical energy that resultsin longitudinal vibrational motion of the ends of the transducerassembly 114. The ultrasonic transducer assembly 114 may comprise atleast one and preferably a stack of, for example, four to eight ceramicpiezoelectric elements 115 with a motion null point located at somepoint along the stack. The ultrasonic transducer assembly 114 mayfurther include an ultrasonic horn 124 that is attached at the nullpoint on one side and to a coupler 126 on the other side. An ultrasonicblade 200 that may be fabricated from, for example, titanium may befixed to the coupler 126. In alternative embodiments, the ultrasonicblade 200 is integrally formed with the ultrasonic horn 124. In eithercase, the ultrasonic blade 200 will vibrate in the longitudinaldirection at an ultrasonic frequency rate with the ultrasonic transducerassembly 114. The ends of the ultrasonic transducer assembly 114 achievemaximum motion with a portion of the stack constituting a motionlessnode, when the ultrasonic transducer assembly 114 is driven at maximumcurrent at the transducer's resonant frequency. However, the currentproviding the maximum motion will vary with each instrument and is avalue stored in the non-volatile memory of the instrument so the systemcan use it.

The parts of the ultrasonic instrument 100 may be designed such that thecombination will oscillate at the same resonant frequency. Inparticular, the elements may be tuned such that the resulting length ofeach such element is one-half wavelength or a multiple thereof.Longitudinal back and forth motion is amplified as the diameter closerto the ultrasonic blade 200 of the acoustical mounting horn 124decreases. This phenomenon is greatest at the node and essentiallynon-existent when the diameteral change is made at an anti-node. Thus,the ultrasonic horn 124, as well as the blade/coupler, may be shaped anddimensioned so as to amplify blade motion and provide ultrasonicvibration in resonance with the rest of the acoustic system, whichproduces the maximum back and forth motion of the end of the acousticalmounting horn 124 close to the ultrasonic blade 200. Motions ofapproximately 10 microns may be achieved at the piezoelectric elements115. Motions of approximately 20-25 microns may be achieved at the endof the acoustical horn 124 and motions of approximately 40-100 micronsmay be achieved at the end of the ultrasonic blade 200.

When power is applied to the ultrasonic instrument 100 by operation ofthe foot pedal 30 or other switch arrangement, the ultrasonic generator12 may, for example, cause the ultrasonic blade 200 to vibratelongitudinally at approximately 55.5 kHz, and the amount of longitudinalmovement will vary proportionately with the amount of driving power(current) applied, as adjustably selected by the user. When relativelyhigh power is applied, the ultrasonic blade 200 may be designed to movelongitudinally in the range of about 40 to 100 microns at the ultrasonicvibrational rate. Such ultrasonic vibration of the blade 200 willgenerate heat as the blade contacts tissue, i.e., the acceleration ofthe ultrasonic blade 200 through the tissue converts the mechanicalenergy of the moving ultrasonic blade 200 to thermal energy in a verynarrow and localized area. This localized heat creates a narrow zone ofcoagulation, which will reduce or eliminate bleeding in small vessels,such as those less than one millimeter in diameter. The cuttingefficiency of the ultrasonic blade 200, as well as the degree ofhemostasis, will vary with the level of driving power applied, thecutting rate or force applied by the surgeon to the blade, the nature ofthe tissue type and the vascularity of the tissue.

As indicated above, the surgical instrument 100 may further include amotor 190 which is employed to apply rotational motion to a tissuecutting blade 220 that is coaxially aligned with the ultrasonic blade200. More particularly, the tissue cutting blade 220 has an axial lumen221 therethrough through which the ultrasonic blade 200 extends. Thetissue cutting blade 220 may be fabricated from, for example, stainlesssteel. In various embodiments, one or more seals 250 of the typedescribed in co-pending U.S. patent application Ser. No. 12/703,866,entitled SEAL ARRANGEMENTS FOR ULTRASONICALLY POWERED SURGICALINSTRUMENTS, now U.S. Patent Application Publication No. 2011/0196398,which has been herein incorporated by reference inn its entirety may beemployed. However, other seal arrangements could also be employed. Themotor 190 may comprise, for example, a conventional stepper motor. Whenused with an encoder 194, the encoder 194 converts the mechanicalrotation of the motor shaft 192 into electrical pulses that providespeed and other motor control information to the control module 24.

As can also be seen in FIG. 1, a drive gear 196 may be attached to themotor shaft 195. The drive gear 196 may be supported in meshingengagement with a driven gear 222 that may be attached to the tissuecutting blade 220. Such arrangement serves to facilitate the rotation ofthe tissue cutting blade 220 about the longitudinal axis A-A when themotor 190 is powered. The tissue cutting blade 220 may also be rotatablysupported within an outer sheath 230 by one or more bearings 224. Theouter sheath 230 may be fixed to the housing 102 and have asubstantially blunt distal end 232. A hole or opening 236 may beprovided through the blunt distal end 232 to enable at least a portionof a distal end 202 of the ultrasonic blade 200 to protrudetherethrough. See FIGS. 1 and 2. The distal end 202 of the ultrasonicblade 200 may have a ball-like shape as shown in FIGS. 1-3 or, in otherembodiments for example, the distal end 202 may have a somewhatflattened portion 206 with an arcuate or rounded distal surface 208 asshown in FIGS. 5 and 6.

The tissue cutting blade 220 may have various configurations. In theembodiment depicted in FIGS. 2-4, the tissue cutting blade 220 has twoopposed arcuate portions 221 that serve to form four tissue cuttingedges 223. As can be seen in FIG. 2, one portion of the tissue cuttingblade 220 is exposed through the distal tissue opening 234. Because inthis embodiment, the tissue cutting blade 220 is not ultrasonicallyactive, the blade 220 may be fabricated from a material that willfacilitate holding sharp edges. For example, the tissue cutting blade220 may be fabricated from, for example, stainless steel or othersuitable materials. In use, the surgeon could use the portion of therotating tissue cutting blade 220 that is exposed through the distaltissue cutting opening 234 to cut tissue and then activate theultrasonic blade 200 when it is needed for coagulation purposes. Thesurgeon would simply contact the target tissue with the exposed portionof the distal end 202 of the ultrasonic blade 200 while activating theultrasonic transducer assembly 114.

FIG. 7 illustrates another surgical instrument 300 of the presentinvention. The surgical instrument 300 includes a housing 302 that mayhouse a transducer assembly 314 that includes an ultrasonic horn 324.The ultrasonic transducer assembly 314 may comprise at least one andpreferably a stack of, for example, four to eight ceramic piezoelectricelements 315 with a motion null point located at some point along thestack. In this embodiment, the transducer assembly 314 is non-rotatablysupported within the housing 302. Power may be transmitted to theultrasonic transducer assembly 314 by conductors 360, 362 which arecoupled to the ultrasonic generator 12 in the control system 10. Thesurgical instrument 300 may include a control arrangement of the typedescribed above and be used in the various modes described above. Themotor 340 may have an encoder 341 associated therewith that communicateswith the control module 24 as was described above. The motor 340 mayreceive power from the motor drive 26 through conductors 342, 343 thatcomprise motor cable 74 that extends through the common sheath 76.

An ultrasonic blade 200 of the types and construction described abovemay be attached to the ultrasonic horn 324 in a manner described aboveand may extend through a bore 342 in a motor 340 that is mounted withinthe housing 302. In alternative embodiments, however, the ultrasonicblade 200 may be integrally formed with the ultrasonic horn 324. Atissue cutting blade 220 of the various types and constructionsdescribed above may be attached to a rotatable portion/shaft of themotor 340. For example, those motors manufactured by NationalInstruments may be used. However, other motors may also be successfullyemployed. The tissue cutting blade 220 may coaxially extend through anouter sheath 230 that is attached to the housing 302. The outer sheath230 may be fabricated from, for example, aluminum, titanium, aluminumalloys, steels, ceramics, etc. The tissue cutting blade 220 may berotatably supported by one or more bearings 332 mounted between thehousing 302 and/or the outer sheath 230. One or more seals 250 of thetype and construction described in one of the aforementioned patentapplications or others may be mounted between the ultrasonic blade 200and the tissue cutting blade 220. The ultrasonic horn 324 may be coupledto the proximal end of the ultrasonic blade 200 in the manner describedabove. In use, the surgeon may use the portion of the rotating tissuecutting blade 220 that is exposed through the distal tissue cuttingopening 234 in the outer sheath 230 to cut tissue and then activate theultrasonic blade 200 when it is needed for coagulation purposes. Thesurgeon would simply contact the target tissue with the distal end 202of the ultrasonic blade 200 while activating the ultrasonic transducerassembly 314. It will be understood that the instrument 300 may be usedin a tissue cutting rotation mode, an ultrasonic mode, or tissue cuttingand ultrasonic mode (“duel mode”).

FIG. 8 illustrates an alternative surgical instrument 300′ that issubstantially identical to surgical instrument 300 described above,except for the following differences. As can be seen in FIG. 8, theultrasonic transducer assembly 314 and the ultrasonic blade 200 arecapable of being moved axially by a trigger 370 that is pivotallycoupled to the housing 302′. In various embodiments, the trigger 370 mayhave a yoke 372 that is configured to engage a portion of the transducerassembly 314 such that when the trigger 370 is pivoted (arrow “B”), theultrasonic transducer assembly 314, and ultrasonic blade 200 moveaxially along axis A-A (represented by arrow “C”). This “gross” axialmotion is distinguishable from ultrasonic axial motion achieved when theultrasonic transducer assembly 314 is powered.

FIG. 9 illustrates another surgical instrument 400 of the presentinvention. The surgical instrument 400 includes a housing 402 that mayhouse an ultrasonic transducer assembly 414 that includes an ultrasonichorn 424. The ultrasonic transducer assembly 414 may comprise at leastone and preferably a stack of, for example, four to eight PZT-8 (LeadZirconium Titanate) ceramic piezoelectric elements 415 with a motionnull point located at some point along the stack. In this embodiment,the ultrasonic transducer assembly 414 is attached to a transducerhousing 430 that is rotatably supported within the housing 402 by adistal bearing 436. The ultrasonic transducer assembly 414 may besubstantially ultrasonically insulated from the transducer housing 430by, for example, epdm elastomeric materials or by a flange placed at aNode and damped by a dampening member such that ultrasonic motion fromthe ultrasonic transducer assembly 414 is not passed to the transducerhousing. A tissue cutting blade 220 of the various types andconstructions described above may be attached to the transducer housing430 for rotatable travel therewith. The tissue cutting blade 220 maycoaxially extend through an outer sheath 230 that is attached to thehousing 402. The tissue cutting blade 220 may be rotatably supported byone or more bearings 432 mounted between the housing 402 and/or theouter sheath 230. One or more seals 250 may be mounted between theultrasonic blade 200 and the tissue cutting blade 200. The ultrasonichorn 424 may be coupled to the proximal end of the ultrasonic blade 200in the manner described above. In alternative embodiments, theultrasonic blade 200 may be integrally formed with the ultrasonic horn424.

This embodiment may include a conventional stepper motor 440. The motor440 may have an encoder associated therewith that communicates with thecontrol module 24 as was described above. The motor 440 may receivepower from the motor drive 26 through conductors 441, 442 that comprisemotor cable 74 that extends through the common sheath 76. The motor 440may have a hollow motor shaft 444 attached thereto that extends througha slip ring assembly 450. The hollow motor shaft 444 may be rotatablysupported within the housing 402 by a proximal bearing 446.

The slip ring assembly 450 may be fixed (i.e., non-rotatable) within thehousing 402 and may include a fixed outer contact 452 that is coupled toconductors 453, 454 that form generator cable 14 as was described above.An inner contact 456 may be mounted on the rotatable hollow drive shaft444 such that it is in electrical contact or communication with outercontact 452. Conductors 453, 454 are attached to the inner contact 456and extend through the hollow motor shaft 444 to be coupled to theultrasonic transducer assembly 414. In various embodiments, tofacilitate ease of assembly and also acoustically isolate the motor 440from the ultrasonic transducer assembly 414, the hollow motor shaft 444may be detachably coupled to the transducer 430 by one of the variouscoupling assemblies disclosed in U.S. patent application Ser. No.12/703,860, entitled ULTRASONICALLY POWERED SURGICAL INSTRUMENTS WITHROTATING CUTTING IMPLEMENT, now U.S. Pat. No. 8,531,064, the disclosureof which has been herein incorporated by reference in its entirety.

When power is supplied to the motor 440, the drive shaft 444 rotatesabout axis A-A which also causes the transducer housing 430 to rotateabout axis A-A. Because ultrasonic transducer assembly 414 and thetissue cutting blade 220 are attached to the transducer housing 430,they, too, rotate about axis A-A. When the clinician desires to powerthe ultrasonic transducer assembly 414, power is supplied from theultrasonic generator 12 to the fixed contact 452 in the slip ringassembly 450. Power is transmitted to the ultrasonic transducer assembly414 by virtue of rotational sliding contact or electrical communicationbetween the inner contact 456 and the fixed contact 452. Those signalsare transmitted to the ultrasonic transducer assembly 414 by conductors460, 462. The surgical instrument 400 may include a control arrangementof the type described above and be used in the various modes describedabove. It will be understood that the instrument 400 may be used inrotation mode, ultrasonic mode, or rotation and ultrasonic mode (“duelmode”).

FIG. 10 illustrates another surgical instrument 500 of the presentinvention. The surgical instrument 500 includes a housing 502 that mayhouse an ultrasonic transducer assembly 514 that includes an ultrasonichorn 524. The ultrasonic transducer assembly 514 may comprise at leastone and preferably a stack of, for example, four to eight PZT-8 (LeadZirconium Titanate) ceramic piezoelectric elements 515 with a motionnull point located at some point along the stack. In this embodiment,the ultrasonic transducer assembly 514 is contained within a sealedtransducer chamber 526 that is rotatably supported within the housing502 by a distal bearing 536. In various embodiments, the sealedtransducer chamber 526 may be fabricated from magnetic material such as,for example, iron, rare earth magnetic materials, etc. A tissue cuttingblade 220 of the various types and constructions described above may beattached to the transducer chamber 526 for rotatable travel therewith.The tissue cutting blade 220 may coaxially extend through an outersheath 230 that is attached to the housing 502. The outer sheath 230 maybe fabricated from, for example, aluminum, titanium, aluminum alloys,steels, ceramics, etc. The tissue cutting blade 220 may be rotatablysupported by one or more bearings 532 mounted between a nosepieceportion 503 of the housing 502 and/or the outer sheath 230. One or moreseals 250 may be mounted between the ultrasonic blade 200 and the tissuecutting blade 220. The ultrasonic horn 524 may be coupled to theproximal end of the ultrasonic blade 200 in the manner described above.In alternative embodiments, the ultrasonic blade 200 may be integrallyformed with the ultrasonic horn 524.

This embodiment includes a motor 540 that may comprise a stepper motorof the type and construction described above. The motor 540 may have anencoder associated therewith that communicates with the control module24 as was described above. The motor 540 may receive power from themotor drive 26 through conductors 541, 542 that comprise motor cable 74that extends through the common sheath 76 (FIG. 1). The motor 540 has amotor shaft 544 attached thereto that is coupled to a magnetic yoke 560which is magnetically coupled to the transducer chamber 526. The motorshaft 544 may be rotatably supported within the housing 502 by aproximal bearing 546.

A movable contact 550 may be fixed to the sealed transducer chamber 526and is coupled to the transducer assembly 514 by conductors 552 and 553.A fixed outer contact 554 may be attached to the housing 502 and iscoupled to conductors 555, 556 that form generator cable 14 as wasdescribed above. When power is supplied to the motor 540, the motorshaft 544 rotates about axis A-A which also causes the transducerchamber 526 to rotate about axis A-A. Because ultrasonic transducerassembly 514 and the tissue cutting blade 220 are attached to thetransducer chamber 526, they, too, rotate about axis A-A. When theclinician desires to power the ultrasonic transducer assembly 514, poweris supplied from the ultrasonic generator 12 to the fixed contact 554.Power is transmitted to the ultrasonic transducer assembly 514 by virtueof rotational sliding contact or electrical communication between thefixed contact 554 and the movable contact 550. Those signals aretransmitted to the ultrasonic transducer assembly 514 by conductors 553,554. The surgical instrument 500 may include a control arrangement ofthe type described above and be used in the various modes describedabove. It will be understood that the instrument 500 may be used inrotation mode, ultrasonic mode, or rotation and ultrasonic mode (“duelmode”).

FIGS. 11 and 12 illustrate another surgical instrument 600 of thepresent invention. The surgical instrument 600 includes a housing 602that may support a hollow transducer housing 620. The hollow transducerhousing 620 may support a plurality of (e.g., four to eight)piezoceramic elements 622 and may have an ultrasonic horn portion 624integrally formed therewith. A series of internal threads 625 may beformed on the distal end portion of the horn portion 624 for attachmentto a hollow ultrasonic blade 630. Ultrasonic blade 630 may be fabricatedfrom, for example, aluminum, titanium, aluminum alloys, steels,ceramics, etc. and have a threaded proximal end 632 for threadedattachment to the threads 625 on the ultrasonic horn portion 624. As canbe further seen in FIG. 11, a proximal end 626 of the transducer housing620 may have threads 627 formed thereon for threaded attachment to athreaded bushing 640. Threaded bushing 640 may have an axial passage 642therethrough for receiving a rotatable tissue cutting or “shaver” blade650 therethrough. In various embodiments, the shaver blade 650 may befabricated from, for example, aluminum, titanium, aluminum alloys,steels, ceramics, etc. and be rotatably supported within the transducerhousing 620 by a bearing 651 that is located at a node “N” in thehousing 620. The proximal end 652 of the shaver blade 650 may beattached to a motor 660. The shaver blade 650 may for example, beattached to a drive shaft 662 of the motor 660 by threads (not shown) orother suitable coupling arrangement. The transducers 622 may receivepower from the ultrasonic generator 12 in the control system 10 throughconductors 628, 629. Motor 660 may communicate with the variouscomponents in the control system 10 through conductors 664, 665.

In various embodiments, the shaver blade 650 may have a distal end 654that may be configured to cut tissue when the blade 650 is rotated aboutaxis A-A. In one embodiment, for example, the distal end 654 has aseries of teeth 656 formed thereon. See FIG. 12. Also in variousembodiments, the shaver blade 650 may have an axial suction lumen 657therethrough. At least one discharge hole 658 is provided through theshaver blade 650 to enable the suction lumen 657 to discharge cut tissueand fluids therethrough into a suction chamber 670 located within thehousing 602. The suction chamber 670 may be sealingly attached to thebushing 640 or be otherwise supported within the housing 602 such thatthe shaver blade 650 extends therethrough. Because the bushing 640 ispart of the acoustic system and attachment of the suction chamber 670 tothe bushing 640 would make it part of the acoustic system as well, it isdesirable for the connection between the suction chamber 670 and thebushing 640 to be located at a Node of vibration. In the embodimentdepicted in FIG. 11, a shaft seal 672 may be provided on the shaverblade 650 to establish a substantially fluid-tight seal between theshaver blade 650 and the suction chamber 670. In various embodiments,the shaft seal 672 may be fabricated from, for example, silicone rubber,epdm rubber, Teflon®, Ultem®, etc. The suction chamber 670 may dischargethrough a flexible hose 674 that communicates with a collectionreceptacle 676 and a source of suction 678.

The instrument 600 may further have an acoustically isolated hollowsheath 680 that extends from the housing 602 to cover a substantialportion of the ultrasonic blade 630. That is, in various embodiments,the hollow sheath 680 may cover all of the ultrasonic blade 630 exceptfor a distal end portion 634 that has a blade opening 635 therein. SeeFIG. 12. The hollow sheath 680 may be fabricated fromflouroethylene-propelene (FEP), silicon or similar materials that canacoustically isolate or acoustically insulate the outside of theultrasonic blade 630. At least one seal 636 may be employed between theouter sheath 680 and the ultrasonic blade 630. Similarly, the ultrasonicblade 630 may be isolated from the shaver blade 650 by at least one seal651. In various embodiments, the seals 636, 651 may comprise one or moreseals of the type described in co-pending U.S. patent application Ser.No. 12/703,866, entitled SEAL ARRANGEMENTS FOR ULTRASONICALLY POWEREDSURGICAL INSTRUMENTS, now U.S. Patent Application Publication No.2011/0196398, which has been herein incorporated by reference in itsentirety. As can also be seen in FIGS. 11 and 12, the distal end portion634 of the ultrasonic blade 630 may be substantially blunt or rounded.

When power is supplied to the motor 660, the drive shaft 662 rotatesabout axis A-A which also causes the shaver blade 650 to rotate aboutaxis A-A. Activation of the source of suction 678 causes suction to beapplied to the suction lumen 657 in the shaver blade 650 to draw tissueinto the opening 635 in the hollow sheath 680 and into contact with therotating shaver blade 650. The source of suction 678 may communicatewith and be controlled by the control system 10 such that suction isonly applied to the lumen 657 when the shaver blade 650 is being rotatedby motor 660.

The surgical instrument 600 may have two primary modes of operation. Onemode is the shaver mode, in which the shaver blade 650 rotates inconcert with suction to cut tissue that enters the opening 636. Theother mode is the ultrasonic coagulation mode. As an ultrasonicinstrument, the ultrasonic blade 630 is driven in a linear ultrasonicvibration mode by the transducers 622. The user is able to coagulatebleeders and tissue as needed with the exposed distal end 634 of theultrasonic blade 630. In use, the instrument 600 can be activated inshaver modes independently or in ultrasonic mode independently. Bothmodes can also be activated together and suction can be turned on andoff at any time. When using the instrument 600 in one of the ultrasonicmodes, the distal end 634 of the ultrasonic blade 630 can be used tocoagulate tissue while the remainder of the device can safely come incontact with tissue outside of the targeted site because it is notultrasonically active.

FIGS. 13-17 illustrate another surgical instrument 700 of the presentinvention. The surgical instrument 700 may include a housing 702 thatmay be manufactured in multiple pieces from, for example, plastics suchas polycarbonate, polyetherimide (GE Ultem®) or metals such as aluminum,titanium or steel that are coupled together by fasteners such as screws,bolts, snap features or may be retained together by adhesive, welding,etc. As can be seen in FIGS. 13 and 15-17, the housing 702 may define asuction chamber 703 that communicates with a suction port 705. Aflexible tube or other suitable conduit 707 may be coupled to thesuction port 705 as well as to a collection receptacle 709 that may belocated within the surgical suite. The collection receptacle 709 may becoupled to a source of suction 711 to apply suction to the suctionchamber 703 through the flexible tube 707 and suction port 705. A motor710 of the type and construction described above may also be supportedwithin the housing 702. The motor 710 has a drive shaft 712 that extendsinto the suction chamber 703. The drive shaft 712 may be supported by abearing 714 in a wall of the suction chamber 703. A seal 716 may also beemployed to achieve a substantially fluid-tight seal between the driveshaft 712 and the wall of the suction chamber 703. The motor 710 maycommunicate with the various components of the control system 10 throughconductors 717, 718 in the manner discussed above.

An ultrasonic transducer assembly 720 that has an ultrasonic hornportion 722 attached thereto or integrally formed therewith may also besupported within the housing 702. The ultrasonic transducer assembly 720may comprise at least one and preferably a stack of, for example, fourto eight lead zirconate titanate (PZT-8) ceramic piezoelectric elements725 with a motion null point located at some point along the stack. Invarious embodiments, for example, a series of internal threads (notshown) may be formed on the distal end portion of the horn portion 722for attachment to an ultrasonic blade 760. Ultrasonic blade 760 may havea threaded proximal end 762 for threaded attachment to the horn portion722 as will be discussed in further detail below. The surgicalinstrument 700 may further include a hollow tissue cutting or “shaver”blade 730 that may be fabricated from, for example, aluminum, titanium,aluminum alloys, titanium alloys, steels, ceramics, etc. A distal end732 of the shaver blade 730 may have serrations 734 formed thereon or,in other embodiments, the serrations may be omitted. In someembodiments, a proximal end 736 of the shaver blade 730 may befabricated for removable attachment to the drive shaft 712 of the motor710. In one embodiment, for example, a “quarter-twist” or bayonet-typecoupling 738 may be employed to couple the proximal end 736 of theshaver blade 730 to a corresponding coupling portion 713 that isattached to the drive shaft 712. Such bayonet coupling arrangements areknown and may facilitate coupling of the shaver blade 730 to the driveshaft 712 by engaging the coupling portions 738, 713 and rotating theblade 730 while the drive shaft 712 remains stationary. Other forms ofcoupling arrangements could also be successfully employed withoutdeparting from the spirit and scope of the present invention. The shaverblade 730 may further have a suction lumen 740 that extendstherethrough. At least one suction hole 742 may provided in the proximalend 736 of the shaver blade 730 to enable the suction lumen 740extending therethrough to discharge into the suction chamber 703 whenthe proximal end 736 is coupled to the drive shaft 712 as illustrated inFIG. 13.

In various embodiments, the surgical instrument 700 may further includean outer sheath assembly 770 that may be fixedly attached to the housing702. In one embodiment, for example, the proximal end 772 of the outersheath assembly 770 may include a quarter-turn or bayonet-type couplingarrangement that is configured for attachment to the distal end 701 ofthe housing 702. However, other known coupling arrangements may beemployed for removably coupling the outer sheath assembly 770 to thehousing 702 without departing from the spirit and scope of the presentinvention. As can be most particularly seen in FIG. 14, the outer sheathassembly 770 may have a shaver blade lumen 774 that extends therethroughand which is sized to rotatably receive the shaver blade 730 therein.Various embodiments may also employ a bearing 776 in the proximal end772 of the outer sheath assembly 770 for rotatably supporting the shaverblade 730 therein. Additional bearing and/or seal arrangements may beemployed to rotatably support the shaver blade 730 within the outersheath assembly 770. The distal end 778 of the outer sheath assembly 770may also have an opening 780 therein to expose the distal end 732 of theshaver blade 730. The distal end 778 of the outer sheath assembly 770may also form a cutting board surface 782 upon which the distal end 732of the shaver blade 730 may oscillate. The outer sheath assembly 770 mayfurther have an ultrasonic blade lumen 790 for receiving the ultrasonicblade 760 therein. The ultrasonic blade lumen 790 may be substantiallyparallel to the shaver blade lumen 774. One or more seal members (notshown) of the type and construction described in the aforementionedpending patent applications that have been incorporated herein byreference or others may be employed to support the ultrasonic blade 760within the ultrasonic blade lumen 790 while achieving a substantiallyfluid tight seal between the blade 760 and the lumen 790.

Assembly of the instrument 700 will now be explained with reference toFIGS. 16 and 17. As can be seen in FIG. 16, for example, the proximalend 762 of the ultrasonic blade 760 is attached to the ultrasonic horn722. In one embodiment, the proximal end 762 of the ultrasonic blade 760is threaded onto the ultrasonic horn 722. In still other embodiments,however, the ultrasonic blade 760 may be integrally formed with theultrasonic horn 722. After the ultrasonic blade 760 is coupled to theultrasonic horn 722, the outer sheath assembly 770 with the shaver blade730 supported therein is oriented such that the distal end 764 of theultrasonic blade 760 is introduced into the lumen 790. The outer sheathassembly 770 is then slid over the ultrasonic blade 760 to bring theproximal end 772 of the outer sheath assembly 770 into engagement withthe distal end 701 of the housing 702. The outer sheath assembly 770 maythen be manipulated in a known manner to couple the bayonet-typecoupling arrangement together. In other embodiments, the outer sheathassembly 770 may be permanently fixed to the housing 702 with adhesive,welding, etc. In still other arrangements, the outer sheath assembly 770may be attached to the housing 702 with removable fasteners such asscrews, bolts, etc.

In use, the control system 10 components may be employed to controlmotor 710 such that the drive shaft 712 is caused to oscillate back andforth about axis A-A which also causes the shaver blade 730 to rotateabout axis A-A. Activation of the source of suction 711 may causesuction to be applied to the suction lumen 740 in the shaver blade 730to draw tissue into contact with the oscillating distal end 732 of theshaver blade 730. Pieces of severed tissue may be drawn in through thesuction lumen 740 and ultimately be collected in the collectionreceptacle 709. If hemostasis is desired, the surgeon can activate theultrasonic transducer assembly 720 to ultrasonically power theultrasonic blade 760. The distal end 764 of the ultrasonic blade 760that protrudes out of the outer sheath assembly 770 (FIG. 13) may thenbe pressed against the bleeding tissue to utilize the ultrasonic energyto stop the bleeding.

FIGS. 18 and 19 illustrate another surgical instrument 800 of thepresent invention. The surgical instrument 800 may include a housing 802that may be manufactured in multiple pieces from, for example, plasticssuch as polycarbonate, polyetherimide (GE Ultem®) or metals such asaluminum, titanium or steel that are coupled together by fasteners suchas screws, bolts, snap features or may be retained together by adhesive,welding, etc. As can be seen in FIG. 18, the housing 802 may define asuction chamber 803 that communicates with a suction port 805. Aflexible tube or other suitable conduit 807 may be coupled to thesuction port 805 as well as to a collection receptacle 809. Thecollection receptacle 809 may be coupled to a source of suction 811 forapplying suction to the suction chamber 803 through the flexible tube807 and suction port 805. A motor 810 of the type and constructiondescribed above may also be supported within the housing 802. The motor810 has a motor drive shaft 812 that extends into the suction chamber803. The motor drive shaft 812 may be supported by a bearing 814 in awall of the suction chamber 803. A seal 816 may also be employed toachieve a substantially fluid-tight seal between the drive shaft 812 andthe wall of the suction chamber 803. The motor 810 may communicate withthe various components of the control system 10 through conductors 817,818 in the various manners described above.

Also supported in the housing 802 is an ultrasonic transducer assembly820 that has an ultrasonic horn portion 822 attached thereto orintegrally formed therewith. The ultrasonic transducer assembly 820 maycomprise at least one and preferably a stack of, for example, four toeight lead zirconate titanate (PZT-8) ceramic piezoelectric elements 821with a motion null point located at some point along the stack. Invarious embodiments, the ultrasonic blade 860 may be attached to thedistal end of the horn portion 822 by, for example, a screw fitting. Thesurgical instrument 800 may further include a hollow shaver blade 830that may be fabricated from, for example, aluminum, titanium, aluminumalloys, titanium alloys, steels, ceramics, etc. A distal end 832 of theshaver blade 830 may have an opening 834 therein that forms two sharptissue cutting edges 835, 837 as shown in FIG. 19. A proximal end 836 ofthe shaver blade 830 may have a driven gear 838 that is retained inmeshing engagement with a drive gear 818 attached to the drive shaft 812of the motor 810. The shaver blade 830 may further have a suction lumen840 that extends therethrough. At least one suction hole 882 may beprovided in the proximal end 836 of the shaver blade 830 to dischargeinto the suction chamber 803 when the proximal end 836 is coupled to thedrive shaft 812 as illustrated in FIG. 18.

In various embodiments, the surgical instrument 800 may further includea shaver blade sheath 870 that may be fixedly attached to the housing802. In one embodiment the proximal end 872 of the shaver blade sheath870 may be fabricated from, for example, a metal material such asaluminum, titanium, steels, titanium alloys or aluminum alloys andinclude a quarter-turn or bayonet-type coupling arrangement that isconfigured for attachment to the distal end 801 of the housing 802.However, other known coupling arrangements may be employed for removablycoupling the shaver blade sheath 870 to the housing 802 withoutdeparting from the spirit and scope of the present invention. As can bemost particularly seen in FIG. 18, the shaver blade sheath 870 may havea shaver blade lumen 874 extending therethrough that is sized torotatably receive the shaver blade 830 therein. Various embodiments mayalso employ a bearing (not shown) in the proximal end of the shaverblade sheath 870 for rotatably supporting the shaver blade 830 withinthe shaver blade sheath 870. Additional bearing and/or seal arrangementsmay be employed to rotatably support the shaver blade 830 within theshaver blade sheath 870. The distal end 878 of the shaver blade sheath870 may for a substantially blunt closed end that has an opening 880therein to expose the distal end 832 of the shaver blade 830.

Also in this embodiment, an ultrasonic blade sheath 890 may be attachedto the housing 802. In various embodiments, for example, the ultrasonicblade sheath 890 may be fabricated from a polymer material such aspolyetherimide, liquid crystal polymers, polycarbonate, nylon or ceramicmaterial and be attached to the housing 802 by screw threads, bonding,press fitting, crimping, etc. The ultrasonic blade sheath 890 mayfurther have an ultrasonic blade lumen 892 extending therethrough forreceiving the ultrasonic blade 860 therein. One or more seal members(not shown) of the type and construction described in the aforementionedpending patent applications that have been incorporated by reference orothers may be employed to support the ultrasonic blade 860 within thelumen 892 while achieving a substantially fluid-tight seal between theblade 860 and the lumen 892. The ultrasonic blade sheath 890 may furtherhave an opening 896 in a distal end 894 to expose a distal end 864 ofthe ultrasonic blade 860.

In use, the control system 10 components may be used to control motor810 such that the drive shaft 812 is rotated about axis A-A which alsocauses the shaver blade 830 to rotate about axis A-A. Activation of thesource of suction 811 will cause suction to be applied to the suctionlumen 840 in the shaver blade 830 to draw tissue in through the opening880 in the distal end 878 of the shaver blade sheath 870 and into theopening 834 in the shaver blade 830. Pieces of severed tissue may bedrawn in through the suction lumen 840 and ultimately be collected inthe collection receptacle 809. If hemostasis is desired, the surgeon canactivate the ultrasonic transducer assembly 820 to ultrasonically powerthe ultrasonic blade 860. The distal end 864 that protrudes out of theultrasonic sheath assembly 890 (FIG. 19) may then be pressed against thebleeding tissue to utilize the ultrasonic energy to stop the bleeding.

The devices disclosed herein can be designed to be disposed of after asingle use, or they can be designed to be used multiple times. In eithercase, however, the device can be reconditioned for reuse after at leastone use. Reconditioning can include any combination of the steps ofdisassembly of the device, followed by cleaning or replacement ofparticular pieces, and subsequent reassembly. In particular, the devicecan be disassembled, and any number of the particular pieces or parts ofthe device can be selectively replaced or removed in any combination.Upon cleaning and/or replacement of particular parts, the device can bereassembled for subsequent use either at a reconditioning facility, orby a surgical team immediately prior to a surgical procedure. Thoseskilled in the art will appreciate that reconditioning of a device canutilize a variety of techniques for disassembly, cleaning/replacement,and reassembly. Use of such techniques, and the resulting reconditioneddevice, are all within the scope of the present application.

Preferably, the various embodiments described herein will be processedbefore surgery. First, a new or used instrument is obtained and ifnecessary cleaned. The instrument can then be sterilized. In onesterilization technique, the instrument is placed in a closed and sealedcontainer, such as a plastic or TYVEK bag. The container and instrumentare then placed in a field of radiation that can penetrate thecontainer, such as gamma radiation, x-rays, or high-energy electrons.The radiation kills bacteria on the instrument and in the container. Thesterilized instrument can then be stored in the sterile container. Thesealed container keeps the instrument sterile until it is opened in themedical facility. Sterilization can also be done by any number of waysknown to those skilled in the art including beta or gamma radiation,ethylene oxide, and/or steam.

In various embodiments, an ultrasonic surgical instrument can besupplied to a surgeon with a waveguide and/or end effector alreadyoperably coupled with a transducer of the surgical instrument. In atleast one such embodiment, the surgeon, or other clinician, can removethe ultrasonic surgical instrument from a sterilized package, plug theultrasonic instrument into a generator, as outlined above, and use theultrasonic instrument during a surgical procedure. Such a system canobviate the need for a surgeon, or other clinician, to assemble awaveguide and/or end effector to the ultrasonic surgical instrument.After the ultrasonic surgical instrument has been used, the surgeon, orother clinician, can place the ultrasonic instrument into a sealablepackage, wherein the package can be transported to a sterilizationfacility. At the sterilization facility, the ultrasonic instrument canbe disinfected, wherein any expended parts can be discarded and replacedwhile any reusable parts can be sterilized and used once again.Thereafter, the ultrasonic instrument can be reassembled, tested, placedinto a sterile package, and/or sterilized after being placed into apackage. Once sterilized, the reprocessed ultrasonic surgical instrumentcan be used once again.

Although various embodiments have been described herein, manymodifications and variations to those embodiments may be implemented.For example, different types of end effectors may be employed. Also,where materials are disclosed for certain components, other materialsmay be used. The foregoing description and following claims are intendedto cover all such modification and variations.

All of the above U.S. patents and U.S. patent applications, andpublished U.S. patent applications referred to in this specification areincorporated herein by reference in their entirety, but only to theextent that the incorporated material does not conflict with existingdefinitions, statements, or other disclosure material set forth in thisdisclosure. As such, and to the extent necessary, the disclosure asexplicitly set forth herein supersedes any conflicting materialincorporated herein by reference. Any material, or portion thereof, thatis said to be incorporated by reference herein, but which conflicts withexisting definitions, statements, or other disclosure material set forthherein will only be incorporated to the extent that no conflict arisesbetween that incorporated material and the existing disclosure material.

What is claimed is:
 1. An ultrasonic surgical instrument, comprising: ahousing; a cutting blade; at least one ultrasonic transducer containedwithin said housing and supported for axial displacement within saidhousing; and an ultrasonic blade protruding from said at least oneultrasonic transducer, wherein axial displacement of said at least oneultrasonic transducer is configured to axially displace said ultrasonicblade relative to said cutting blade.
 2. The ultrasonic surgicalinstrument of claim 1, wherein said cutting blade is supported forselective rotational displacement relative to said housing, and whereinsaid ultrasonic surgical instrument further comprises an outer sheathcoupled to said housing and supporting said cutting blade therein, saidouter sheath having a closed distal end with a distal tissue openingtherein to expose a distal tissue cutting portion of said cutting bladeand wherein a distal end of said ultrasonic blade protrudes through anopening in said closed distal end of said outer sheath.
 3. Theultrasonic surgical instrument of claim 2, wherein at least a portion ofsaid distal end of said ultrasonic blade that protrudes through saidopening in said outer sheath is rounded.
 4. The ultrasonic surgicalinstrument of claim 1, comprising a motor, wherein said ultrasonic bladeextends through a hollow passage in said motor.
 5. The ultrasonicsurgical instrument of claim 4, wherein said at least one ultrasonictransducer is housed within a transducer housing coupled to said motor.6. The ultrasonic surgical instrument of claim 5, wherein saidtransducer housing is attached to said motor by a magnetic couplingarrangement.
 7. The ultrasonic surgical instrument of claim 1,comprising an actuator member coupled to said housing and interactingwith said at least one ultrasonic transducer to facilitate the selectivegross axial movement of said at least one ultrasonic transducer relativeto said housing.
 8. The ultrasonic surgical instrument of claim 1,wherein said cutting blade has a plurality of cutting edges formedthereon.
 9. An ultrasonic surgical instrument, comprising: a housing; atleast one ultrasonic transducer contained within said housing andsupported for axial displacement within said housing; an ultrasonicblade coupled to said at least one ultrasonic transducer, wherein axialdisplacement of said at least one ultrasonic transducer is configured toaxially displace said ultrasonic blade; and a cutting blade.
 10. Theultrasonic surgical instrument of claim 9, wherein said cutting bladehas a suction lumen therein that communicates with a source of suction.11. The ultrasonic surgical instrument of claim 10, comprising a suctionchamber within said housing, said suction chamber communicating withsaid source of suction and said suction lumen in said cutting blade. 12.The ultrasonic surgical instrument of claim 10, comprising an outersheath coupled to said housing such that said ultrasonic blade extendstherethrough and at least a portion of a distal end of said ultrasonicblade extends distally out of said outer sheath.
 13. The ultrasonicsurgical instrument of claim 12, wherein said outer sheath is connectedto said ultrasonic blade by an acoustically isolating material.
 14. Theultrasonic surgical instrument of claim 12, wherein said outer sheath isin direct contact with said ultrasonic blade.
 15. The ultrasonicsurgical instrument of claim 9, comprising a motor coupled to saidcutting blade for axially moving said cutting blade within saidultrasonic blade.
 16. An ultrasonic surgical instrument, comprising: ahousing; a cutting blade; at least one ultrasonic transducer containedwithin said housing; and an ultrasonic blade protruding from said atleast one ultrasonic transducer, said ultrasonic blade beingsubstantially parallel to said cutting blade.
 17. The ultrasonicsurgical instrument of claim 16, wherein said cutting blade has asuction lumen extending therethrough that communicates with a source ofsuction.
 18. The ultrasonic surgical instrument of claim 16, whereinsaid cutting blade is supported within a cutting blade lumen in acutting blade outer sheath attached to said housing and wherein saidultrasonic blade extends through an ultrasonic blade lumen in anultrasonic outer sheath attached to said housing.
 19. The ultrasonicsurgical instrument of claim 18, wherein said cutting blade outer sheathis made from a first material and wherein said ultrasonic outer sheathis made from a second material that differs from said first material.